[Insert name and address of relevant licensing authority and its reference number (optional)]
Application for a minor variation to a premises licence or club premises certificate under the
Licensing Act 2003
PLEASE READ THE FOLLOWING INSTRUCTIONS FIRST
Before completing this form please read the Guidance Notes at the end of the form, especially Note
1.
If you are completing this form by hand please write legibly in block capitals. In all cases ensure that
your answers are inside the boxes and in black ink. Use additional sheets if necessary.
Once completed please send your application to the relevant licensing authority. You may wish to
keep a copy of the completed form for your records.
(Insert name(s) of applicant)
being the premises licence holder(s)/club holding a club premises certificate, apply to vary a
premises licence under section 41A/club premises certificate under section 86A of the Licensing Act
2003 for the premises described in Part 1 below.
Part 1 – Premises details
Postal address of premises (or, if none, ordnance survey map reference, or description)
Post town
Postcode
Telephone number at premises (if any)
Premises licence number/club premises certificate number
Brief description of premises (Please see Guidance Note 2)
Part 2 – Applicant Details
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I am/we are the premises licence holder/club premises certificate holder. (Please delete as
appropriate)
Contact phone number in working hours (if any)
Applicant Postal address IF DIFFERENT FROM PREMISES ADDRESS
Post town
Postcode
Please provide email address if you would prefer us to contact you by email (optional)
Part 3 – Proposed variation(s)
Please tick
Do you want the proposed variation to have effect as soon as possible?
Yes
No
DDMMYYYY
If not, from what date do you want the variation to take effect?
Do you want the proposed variation to have effect in relation to the introduction of the late night
levy? (Please see Guidance Note 3)
Yes
No
Please describe the proposed variation(s) in detail in the box below and explain why you
consider that they could not have an adverse effect on the promotion of any of the licensing
objectives (See Guidance Note 1). This should include whether new or increased levels of
licensable activities will be taking place indoors or outdoors (indoors may include a tent):
Details of proposed variation(s) (Please see Guidance Note 4)
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Details of proposed variation(s) (Continued)
Part 4 – Operating Schedule
Please tick those parts of the Operating Schedule which would be subject to change if this
application to vary was successful.
Provision of regulated entertainment
Please tick all that apply
a. plays
b. films
c. indoor sporting events
d. boxing or wrestling entertainment
e. live music
f. recorded music
g. performances of dance
h. anything of a similar description to that falling within (e), (f) or (g)
Provision of late night refreshment
Supply of alcohol
(Note that this can only relate to reducing licensed hours, or moving them without any overall
increase between 7am and 11pm)
Please tick to indicate you have enclosed the following:
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I have enclosed the premises licence/club premises certificate
I have enclosed the relevant part of the premises licence/
club premises certificate
I have included a copy of the plan
(this is necessary if the proposed variation will affect the layout)
If you have not ticked one of the previous three boxes, please explain why in the box below.
Reasons why you have not enclosed the premises licence/club premises certificate or
relevant parts.
Any further information to support your application. (See Guidance Note 5)
CHECKLIST:
Please tick to indicate agreement
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I have made or enclosed payment of the fee; or
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I have not made or enclosed payment of the fee because this application has been made in
relation to the introduction of the late night levy.
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I have enclosed the plan, if appropriate, of the premises in scale [1mm to 100mm], unless
otherwise agreed with the licensing authority.

I have enclosed the premises licence/club premises certificate or relevant part of it or
provided an explanation.

I understand that if I do not comply with the above requirements my application will be
rejected.

I understand that I must now advertise my application for a continuous period beginning on
the first working day after the day on which the application was given to the relevant
licensing authority and ending at the expiry of the ninth consecutive working day after that
day.
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IT IS AN OFFENCE, LIABLE ON SUMMARY CONVICTION TO A FINE NOT
EXCEEDING LEVEL 5 ON THE STANDARD SCALE, UNDER SECTION 158 OF THE
LICENSING ACT 2003, TO MAKE A FALSE STATEMENT IN OR IN CONNECTION
WITH THIS APPLICATION.
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Part 5 – Signatures and Contact Details
(See Guidance Note 6)
Premises Licence: Signature of applicant (the current premises licence holder) or applicant’s
solicitor or other duly authorised agent (see Guidance Note 7). If signing on behalf of the applicant,
please state your name and in what capacity you are authorised to sign:
Signature
Date
Capacity
Where the premises licence is jointly held, signature of 2nd applicant (the current premises
licence holder) or 2nd applicant’s solicitor or other authorised agent (See Guidance Note 8). If
signing on behalf of the applicant, please state in what capacity.
Signature
Date
Capacity
Where the premises are a club
I (insert full name)
authority to bind the club.
make this application on behalf of the club and have
Signature
Date
Capacity
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Contact name (where not previously given) and address for correspondence associated with
this application. (See Guidance Note 9)
Post town
Telephone number (if any)
Postcode
If you would prefer us to correspond with you by email
your email address (optional)
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Notes for Guidance
1. General Note: The minor variations process can only be used for variations that could have no adverse
impact on the promotion of any of the four licensing objectives. (These are: the prevention of crime and
disorder; public safety; the prevention of public nuisance; and the protection of children from harm.)
It cannot be used to:
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extend the period for which the licence has effect;
vary substantially the premises to which it relates;
specify, in a premises licence, an individual as the designated premises supervisor;
add the sale by retail or supply of alcohol as an activity authorised by a licence or certificate;
authorise the sale by retail or supply of alcohol at any time between 11pm and 7am;
authorise an increase in the amount of time on any day during which alcohol may be sold by retail
or supplied;
include the alternative licence condition referred to in section 41D(3) of the Licensing Act 2003 in
a premises licence.
2. Description of premises: For example the type of premises, its general situation and layout and any other
information which could be relevant to the licensing objectives. This should include any activities in or
associated with the use of the premises which may give rise to concern in respect of children regardless of
whether you intend children to have access to the premises, for example (but not exclusively) nudity or
semi-nudity, films for restricted age groups, the presence of gaming machines etc.
3. You do not have to pay a fee if the only purpose of the variation for which you are applying is to avoid
becoming liable to the late night levy.
4. Give full details of all the proposed variation(s). Failure to provide sufficient information may lead to
the refusal of your application. Details should include a description of the proposed variation(s) in terms as
precise as possible. If you are not precise, the licensing authority may decide that the changes you propose
would be potentially broader in scope than you intend and reject your application as not being a ‘minor’
variation. You should also include a statement about why you consider the variations proposed could not
have an impact on the licensing objectives listed in section 4(2) of the Act. You should cover each of the
objectives that could possibly apply to your proposal (or if more than one, to each proposal) and say why
you think there could be no adverse impact on that objective. Your application will be assisted by
including as much information as you can about this. (However, there is a box at the end of the form for
‘further information’, and this should be used for any relevant background information not directly
related to the variation.) Relevant information includes:
a) Variations to licensable activities/licensing hours (all timings should be given in 24 hour clock e.g.
16.00. Only give details for the days of the week when you intend the premises to be used for the activity),
such as:
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Whether new or increased levels of licensable activities will be taking place indoors or outdoors
(indoors may include a tent);
Relevant further details, for example whether music will be amplified or unamplified;
Standard days and timing when the activity will take place, including start and finish times;
Any seasonal variations in timings, e.g. additional days during the summer; and
Non-standard timings, e.g. where you wish the activity to go on longer on a particular day such as
Christmas Eve.
b) Variations to premises/club layout: If you are applying for a variation to the layout of your premises,
you must include a revised plan. You should be aware that your application is likely to be refused if the
proposed variation could:
 increase capacity for drinking on the premises;
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affect access between the public part of the premises and the rest of the premises or the street or
public way, e.g. block emergency exits or routes to emergency exits; or
impede the effective operation of a noise reduction measure.
c) Revisions, removals and additions of conditions: The minor variation process may be used to remove
conditions which are out of date or invalid and to revise conditions which are unclear (as long as the
intention and effect remains the same). It can also be used to add a new condition volunteered by the
applicant or mutually agreed between the applicant and a responsible authority, such as the police or the
environmental health authority (subject to impact on the licensing objectives).
d) Variations to opening hours: Details of any changes to hours when the premises or club is open to the
public.
5. Further information: You should use this box to provide any additional evidence to support your claim
that the proposed variation is ‘minor’ and could not have an adverse impact on the promotion of the
licensing objectives.
6. Signatures: The application form must be signed.
7. Authorised agent: An applicant’s agent (e.g. solicitor) may sign the form on their behalf and, in so
doing, will be confirming that they have actual authority to do so.
8. 2nd Applicant: Where there is more than one applicant, both applicants or their respective agents must
sign the application form.
9. This is the address which we shall use to correspond with you about this application. This might not be
the same as the address of the premises or applicant, but these addresses must also be provided.
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